Monthly Archives: August 2012

The Killing Fields

August 30, 2012 – Phnom Penh, Cambodia

Our delegation made the sad and sacred journey to a place on the outskirts of Phnom Penh known as the “killing fields,” yesterday. Over a three year period ending January 7, 1979, many thousands and thousands of innocent men, women and children were brutally murdered then buried in shallow graves in this former chinese burial ground. There are 243 other such sites in Cambodia. These killings were the results of an attempt by the Khmer Rouge, led by Pol Pot, to destroy the people of Cambodia and create a cleaner race of people. Today, visitors come to this place to remember how such tragedies effect mankind and to pay tribute to the lives that were lost in this atrocity. Delegates did the same as they viewed the location called “S-21″ (known also as Security 21 – replacing the word, Prision 21, to disguise its intent) – a former school taken over during the war and converted into a prison, including torture chambers where Cambodian political prisoners were tormented before their death. The Khmer Rouge hoped to procure information needed to identify those who did not support the regime. May they all rest in peace.

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The Future of Nursing in Cambodia

August 28, 2012 – Phnom Penh, Cambodia

This morning the delegation visited Chenla University (www.chenla-u.com) in Phnom Penh, Cambodia. This univiersity was accreditated in 2007 by the Royal Govenment of Cambodia and its Accreditation Committee; has 148 qualitified faculty members (8 PhDs – all male) and approximately 5000 students. The delegation met with with university president, Sin Khandy, and members of his faculty to dialogue on the state of affairs of Nursing in Cambodia and his vision for the future.

Similar to the other discussions the delegation has had, Khandy was most interested in telling us about Cambodia’s needs and ask for our advice achieving their vision for improving the qualififications of the nurse and his/her role in the delivery of health care in their country. Sin Khandy also shared a goal of having nurses in Cambodia, similar to nurses in the Phillipines, become qualified and to have enough of them so that they can work in other countries around the world. The latter is likely an economic need for this poor country.

Delegates shared their recommendations for Cambodia to continue to develop a standardized curriculum for all programs for nursing (public and private); for Cambodia to have a licensing process and for it to also be standardized; to continue to elevate the educational level (BSN) and role of the nurse (have a distinct role for the nurse, separate from the physician); and for their nurses to have proficiency in English. We also shared the importance Cambodia having enough qualitifed nurses for its people as a vital first step before seeking their nurses capacity to work out side of their country.

Currently, Cambodia, which has roughly 14 million people, has an estimated 6,000 nurses. Most of these nurses only have 1 year of nursing education post their secondary education and provide basic technical skills under the direction and supervision of physicians. There is however, a strong desire on the part of Cambodia nursing faculty to advance the knowledge and skills of the nurse, and the nurses and students we met held an abundance of optimism and openness to learn from everyone. We visited a classroom of student nurses who were learning fundamentals of nursing. These students were chosen because they tested well and met this university’s leader’s requirement of possessing the necessary hope and optimism for the future state of Cambodia.

Our group then went to the Ministry of Health’s Office to meet with one of its highest officials, Dr. Thir Kruy, Ministry of Health Secretary of State. This was a very prestigious invitation and we heard from a very esteemed leader who also shared a promising vision for nursing in Cambodia. Dr. Kruy acknowledged the benefits to patient care that he witnessed while he was working full time in hospitals, and knew that elevating the qualifications and role of the nurse would lead to improved healthcare and well being of Cambodia people. He acknowledge that his country was very poor; that most people lived in rural settings and there was so much to rebuild after the war just to meet survival needs, yet he was also demonstrated resolve in Cambodia’s future success. Dr. Kruy shared with pride an important report of progress, “Health Care Sector Progress for the Kingdom of Cambodia, 2011.” It held a summary of the country’s Health Care Strategy for 2008 – 2015 and posted metrics of success such as a sharp decline in infant and maternal mortality. It is noteworthy that this country has accomplished a great deal in a short period of time despite the challenges it has and continures to face.

After a wonderful lunch in a local restaurant in town, our group toured the National Museum of Cambodia and Cambodia’s Royal Palace (a blue flag flying along the left side of the palace signified that hat the King was in residence). We learned much through those that spoke with us at these important sites and symbolized in the art work on display that country holds on to both its Buddist and Hindu beliefs, and wants to be known for its hundreds of years of historical peace and not the distributive wars that plagued their country.

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Delegate Reflections

“This trip has opened a window into two cultures that are rich with history and continuing to move into the 21st Century. The people are genuine, welcoming and open about their challenges. They meet those challenges with a spirit and optimism that is inspiring.”

- Susan Kosman, Wethersfield, CT

“I came on this trip because of my interest in the history of Vietnam and its influence on my family, friends, and young-adult years. Having joined the AONE trip to China in 2007, I was familiar with the quality of planning, professional meetings, and networking that would be a part of the trip. My reflection on this trip: it is evident that the ‘call to care’ drives nursing practice and nursing leadership in these impoverished countries. The hearts of nursing are hard at work to improve practice and care.”

- Deborah Gerber, Los Lunas, NM

“You cannot glimpse the heart of a people until you have created meaningful dialogue. This is what People to People International is about, and this journey has been the most successful and touching of any others I have made.”

- Louis Wilson, Norfolk, VA (5th People to People trip)

“My heart cried tears as I viewed the hospitalized sick children of Vietnam and Cambodia. Those tears flowed into the wishing well of health care needs for the children of these countries.”

- Bob Dehaemers, Arlington, TX

Kingdom of Cambodia Ministry of Health, Secretary of State meets with AONE delegation

AONE President, Laura Caramanica, with Cambodian nursing students

National Pediatric Hospital, Phnom Phen, Cambodia

August 28, 2012 – Phnom Phen, Cambodia

Yesterday, our delegation visited the National Pediatric Hospital in Phnom Penh, Cambodia. Phnom Penh is Cambodia’s capital city. The hospital’s physician director, Dr. Chhoury Y Meng, and Mr. Virya Koy RN, MNSC, Ministry of Health Hospital Services Department met with the delegation. In a passionate and factual presentation, Dr. Meng described his leadership journey to the head of this 150 bed pediatric hospital which was built in 1975. During the Khmer Rouge period the Hospital was left unoccupied until the 1980′s. By that time the hospital needed full restoration and replacement of medical staff that was sorely lacking. Dr Meng, then 4 years into his 7 year expected residency trained in a compressed program to become one of the few doctors available to bring this children’s hospital online. Today, the National Pediatric Hospital has achieved some phenomenal outcomes (decrease in mortality and increasing excelence in care) with the limited resources that the government can provide. Today, the hospital has 112 female nurses and 82 male nurses, and, when they surge to 200 patients a day, there can be no more staff added as staff are hired only once a year and even then they only receive what the government can affortd to give them. The Hospital trains students from many disciplines and provides an excellent teaching environment under Dr. Meng’s direction.

Similar to other Hospitals our delegates visited, this one is limited only its material resources, but it’s medical and nursing personnel stand ready to do whatever it takes to meet their patients needs. Nurses and physicians work long hours, and during epidemics can work almost non-stop. Dr. Meng described his successful appeal to get clinical knowedge and material resources for his staff and though language barriers exist, access to enough members of his medical team, this center for pediatric care is successful addressing the main health care needs of its small patients (e.g., diarrhea, respiratory illness, and dengue hemorraghic fever). Dr. Meng argued and procured AIDS treatment for children shortly after the first case of AIDS was identified back in early 1990′s even though he was told, “It is not protocol!” This leader and committed physician is clearly responsible for the success of the National Pediatric Hospital. His commitment to his patients and staff will be sorely missed when he retires shortly. He asked for whatever we can share with his staff to teach them what they need to know to become better. He described a process that comes from his experience and this is what it fundamental to their successful process – Those who know more, train those who know less.

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Visiting Sacred Places

Sunday, August 26, 2012

The delegation visited historical and sacred places today: the Temples of Angkor, located near Siem Reap, Cambodia. Angkor was the ancient capitol of the Khmer Empire in Cambodia. The Temples of Angkor are one of the most magnificent sites in Southeast Asia. The delegates traveled by tuk-tuk (an auto rickshaw – a small motorcycle attached to a passenger cart) to the first temple the delegation visited, Angkor Wat. It was built from 1113 – 1150 under King Suryavarman II, who ruled during the period. The ancient inhabitants of the area were of Hindu religious orientation. The leaders of Khmer established temples throughout their empire. Many visitors to Angkor Wat seek guidance, good fortune, safety, and prosperity. The strong color of orange draping some statues symbolizes fire or good luck.

The members of the delegation were struck by how well the temples have held up over almost 900 years. Preservation and restoration efforts supported by several countries are under way. Impressive sandstone reliefs carved ceiling to floor throughout Angkor Wat tell various stories. The delegation’s guide, Chan, interpreted one of the stories from the relief carvings for the group. It was the ancient Sanskrit epic story of Ramayana whose wife was abducted by king of Sri Lanka, Ravana. In the end, good triumphed over evil in the story, and Ramayana rescued his wife from the evil Ravana.

The Kingdom of Cambodia is one of the poorest countries in the world. The delegates saw the contrast between the life of the citizens living alongside beautiful gardens, hotels, and buildings. It gave the delegates pause to consider the great transition this country is going through as it rebuilds itself from the long years of war that devastated this beautiful country and its nice people.

Photos from Angkor

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Welcome to Siem Reap, Cambodia

After settling into the Victoria Angkor, the delegation visited the Angkor Children’s Hospital (AHC) (www.angkorhospital.org). AHC is a project supported by Friends Without a Border. The visit started off with a brief presentation by hospital director, Bill (Dr. Bill) Houseworth, MD and Director of Nursing, Mr. Som Sophal. In setting the context for the operation of AHC, it was important to understand that Cambodia has only had peace for 13 years, and the infrastructure to support healthcare and hospitals is still being established. The hospital opened in January 1999 and has two goals: 1) to provide high quality care for children in a warm, supportive environment, and 2) act as a medical education center for Cambodia. Care for children at AHC is free, and patients come to AHC from long distances.

Basic nursing education in Cambodia is 1 – 3 years. A Primary Nurse has one year of training. Three years of training leads to an associate degree, and four years of training leads to a bachelor’s degree. There are no master’s or PhD programs in Cambodia currently. The 142 nurses working at AHC (70 female and 72 male) graduated from five surrounding area schools. The nurses that work at AHC are interested in enhancing their leadership skills and obtaining their bachelor’s degrees. Nurses work 12 hours shifts, and have nurse-patient ratios of 1-to-1 or 1-to-2 in the intensive care unit and 1-to-6 in inpatient care areas outside the Intensive care unit. The hospital serves as a clinical training site form healthcare students. Units are crowded, overflowing into the hallway, and non-clinical space has been converted into clinical space. Recently, increased numbers of patients with Dengue fever have forced AHC to turn patients away.

Nurses have been placed in key leadership positions throughout the hospital over the past few years, and Dr. Bill has been a strong proponent of this change. The AHC nurses have implemented the nursing process and are exercising nursing judgment in the delivery of care. The Cambodian Ministry of Health has asked AHC to serve as a model for the country in implementing the nursing process.

The lack of infrastructure is one of the unique challenges of providing healthcare in Cambodia. The high rate of poverty is another factor. The common health conditions that AHC treats include acute respiratory conditions, severe malnutrition, and infectious diseases. AHC has received funding from USAID to improve home care for HIV/AIDS. The delegation was impressed with the number and type of education programs for families offered at AHC, including cooking and nutrition classes.

The delegation left the visit with tremendous admiration for the strength of nursing and medical leadership at AHC and their commitment to caring for the children of Cambodia.

Goodbye Vietnam!

Saturday morning, August 25, 2012

The delegation said goodbye to Ho Chi Minh City, Vietnam this morning, and traveled to Siem Reap, Cambodia. This afternoon the delegation will visit Angkor Hospital for Children (AHC). This is a pediatric teaching hospital that works in cooperation with the Cambodian government to provide free, quality care to impoverished children in Siem Reap. Since 1999, AHC has provided service to more than 1 million patients as well as providing education to thousands of Cambodian health workers and prevention training to families.

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